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Three Northern Kentucky nursing homes have 19 residents or workers who have tested positive for COVID-19. The 19 cases account for 51% of the Kentucky nursing home residents or workers who have the highly contagious upper respiratory disease caused by the novel coronavirus, according to data released by the state Monday.

Whether any of them are among the 11 Kentucky nursing home residents who have died so far in the pandemic isn't clear because officials aren't sharing that information, citing privacy laws.

Hot spots of COVID-19 patients have popped up at U.S. nursing homes, in part because elderly people often have weakened immune systems as well as other underlying health problems.

Basic infection control also is an ongoing struggle for nursing homes. Government health inspectors have cited more nursing homes for failing to ensure that workers follow strict prevention and infection control rules than for any other type of violation, according to a Kaiser Health News data analysis of federal records distributed by the Associated Press.

[This story is being provided for free to our readers during the coronavirus outbreak. Consider supporting local journalism by subscribing to the Enquirer at cincinnati.com/subscribe.]

But communication about those Northern Kentucky patients – detailing where they are and how they are being treated – has been uneven across the region.

On Monday, the health department reported there were seven additional deaths in Northern Kentucky connected to COVID-19, pushing the region's total to 13. All the people who died were older than 60 years old and had underlying health issues.

The department on Tuesday declined to answer if any COVID-19 related deaths were residents at local nursing homes to "to protect the privacy of the patients and their families," said department spokesperson Laura Brinson.

"NKY Health and the Kentucky Department for Public Health continue to work with local long-term care agencies to implement infection control practices from the state and the Centers for Disease Control and Prevention," she said in an email to The Enquirer.

Here are the three nursing homes plus a rehab hospital with cases in Northern Kentucky, according to a report from Kentucky's Office of the Inspector General.

Rosedale Green, Kenton County

Eight residents tested positive.

One employee tested positive.

One resident's test is pending.

“Unfortunately, like many other providers across the health care continuum in Kentucky, Rosedale Green has experienced both COVID positive and COVID suspicious persons,” the nonprofit nursing home wrote in a media statement.

The statement said Rosedale Green staff has been transparent with families, local and state officials about its COVID-19 obligations. Three weeks ago, staff began to restrict visitors, screen staff and residents, and use personal protective equipment.

The nursing home had six health citations in an October 2019 inspection, which is slightly above the Kentucky statewide average of 5.4. Nationally, nursing homes average 8.2 citations per inspection. The 2019 inspection resulted in a fine of $13,790, federal records show, although details about the fine were not available.

There has been one complaint-triggered inspection at Rosedale Green, located at 4250 Glenn Ave. in Latonia, in the past three years, according to the records.

The city of Covington has been in regular communication with the nursing home, according to Fire Chief Mark Pierce.

The department has taken nine residents from Rosedale Green to the hospital for flu-like symptoms since March 23, Pierce said. The department also arranged to get daily updates from the nursing home.

“We’ve been told that the nursing home is isolating residents with such symptoms on a single floor in a separate wing,” Pierce said. “It’s also made changes to its visitors' policy.”

If a patient is not in a life-threatening situation, staff would bring them to the door to meet Covington first responders to limit contact within the facility, Pierce said.

“Obviously, this is a very vulnerable population in a confined space, and from our end, we’re doing everything we can to protect them and respond to them,” Pierce said.

Coldspring Transitional Care Center.(Photo: Mark Wert/The Enquirer)

Coldspring, Campbell County

Eight residents tested positive.

One employee tested positive.

Two residents' tests are pending.

Two employees' tests are pending.

When Coldspring residents were admitted to the hospital with high fevers they were tested for COVID-19 and got positive results, according to Kim Majick, chief development officer for Carespring, the Loveland-based for-profit company that runs Coldspring.

Coldspring residents were tested at hospitals for COVID-19. Some first received a negative result, then were tested again because they were still having symptoms nobody could explain, Majick said. They tested positive on a second test.

The facility got its first positive test result on Sunday, March 29. Since then, they've been in contact with the state health department and local health department, Majick said.

In early March, the company started screening staff members by taking temperatures when employees entered and left work and asked if they had symptoms or if they had been around anyone who had symptoms.

Residents have their temperatures and oxygen levels checked twice a day.

It scored four stars for health inspection ratings and a perfect five stars for quality measures such as residents with improved mobility and getting vaccinations. It scored below average for staffing, earning two of five stars. The score was diminished because a registered nurse spends an average of 33 minutes per day with each Coldspring resident, a number that's lower than the state or federal averages.

Coldspring was issued two health citations during a January 2019 inspection. The Kentucky average per inspection is 5.4 citations and the national average is 8.2, according to Nursing Home Compare.

Two fire safety citations were assessed against the facility earlier this year. The state average is 1.5, while the national average is 3.0, federal documents show.

"Our people at the building, they feel really bad. They love those patients. ... The numbers haven't gone up, but it doesn't mean they won't. It's such a sneaky virus," said John Muller, the chief operating operator of Carespring.

The facility restricted visits in early March and started using personal protective gear, which includes goggles and face masks.

Residents also received iPads to video chat with their families. Others have had birthday parties through windows, too, Muller added.

Madonna Manor, Kenton County

One resident tested positive.

One resident's test is pending.

No sick employees to date.

Officials at Madonna Manor sent a letter to other residents and employees about the COVID-19 patient at the facility, according to Christine Wasserman, director of communications for CHI Living Communities, Madonna Manor’s parent company.

Wasserman declined to share information about the individual’s age or gender due to privacy laws.

“Along with numerous precautionary measures we’ve already implemented and continue – restricting visitors, suspending communal activities, consistently monitoring our patients and assessing staff for potential symptoms, and being vigilant about best infection control practices, we will adapt our procedures as more is known about COVID-19 and recommendations published,” Wasserman said in a statement.

Gateway Rehabilitation Hospital, Boone County

One patient tested positive.

Gateway Rehabilitation Hospital was included in the state’s list of affected nursing homes but it’s actually a rehabilitation hospital where 70% of its patients go home after treatment, according to chief executive officer Frank Schneider. Most of their patients are over 60 years old, he said.

Schneider declined to share the gender or age for the rehab hospital's COVID-19 patient.

When the patient felt, the hospital sent them to St. Elizabeth Healthcare where the patient received a positive test for COVID-19. Schneider said the patient will likely be back at his hospital to complete their physical rehabilitation once the patient is cured.

Who knows what's happening?

When a nursing home in Kentucky has a patient test positive for COVID-19, they are required to report that to the Kentucky Department of Public Health, according to Sherry Culp, state ombudsman for the Nursing Home Ombudsman Agency of the Bluegrass. That organization aims to improve the quality of care for residents in nursing homes.

The Northern Kentucky Health Department has the same information, according to interviews with Culp, Northern Kentucky elected officials and the Northern Kentucky Area Development District, which is the group that employs the Northern Kentucky District Ombudsman to watch for nursing homes.

The Northern Kentucky ombudsman received COVID-19 patient information from some nursing homes, but it’s been at their discretion, according to Anne Wildman, associate director of human services at the development district.

At this time, Wildman said no plans have been made to share nursing home case information with the public.

The health department hasn’t yet released the nursing home case statistics. Doing so could help ease local rumors by adding transparency during the pandemic, Culp told The Enquirer.

Culp used Louisiana’s nursing home COVID-19 as an example. Each day, the state updates a map to show which nursing homes have COVID-19 cases. That’s the kind of transparency Culp’s organization would like to see from Kentucky, she said.

Kenton County Judge-Executive Kris Knochelmann disagreed.

“What’s going to change if you’re informed?” Knochelmann asked. Instead, he said everyone should act as if everyone around them already has COVID-19 to practice the best social distancing.

Knochelmann gets daily updates from the health department about local cases. Each day, the department shares new case information with him, including if any are in a long-term care facility, he said. But, the health department does not share which nursing home has cases with him.

The department does share if there’s been a death, he said. Knochelmann declined to answer if there’s been a COVID-19 related death in a Northern Kentucky nursing home.

Enquirer reporter Deon J. Hampton and the Courier Journal contributed to this report.

Julia is the Northern Kentucky government reporter through the Report For America program. Anonymous donors pledged to cover the local donor portion of her grant-funded position with The Enquirer. If you want to support Julia's work, you can donate to her Report For America positionat this website or email her editor Carl Weiser at cweiser@cincinna.gannett.com to find out how you can help fund her work.

Do you know something she should know? Send her a note at jfair@enquirer.com and follow her on twitter at @JFair_Reports.